Preliminary Experience writh Cryopreserved Saphenous Vein Allografts as a Conduit for Femoropopliteal Revascularization

Abstract

The saphenous vein, either reversed or in situ, has become the conduit of choice for femoropopliteal revascularization. In fact the patency rates with use of prosthetic (polytetrafluoroethylene or Dacron) or other autogenous veins (umbilical, cephalic, and basilic) bypass grafts to the inafrageniculate vessels have been disappointing.

Cryopreserved saphenous vein allografts have been used as an alternative conduit for arterial reconstruction since the 1960s, and more recently the improvement in treatment and cryopreservation techniques has produced good long-term results.

From January 1993 to July 1994 the authors used saphenous vein allografts in 12 patients and 16 extremities with femoropopliteal arterial disease diagnosed angiographically.

Allografts were used because the patients had peripheral varicose veins, had had previous saphenous vein thrombophlebitis, had had previous saphenous vein stripping, or had had saphenous vein used for coronary artery bypass grafting. Allograft veins were prepared from selected saphenous veins in isotonic solution, stored at 4°C, and kept frozen until arrival in the operating room. The femoropopliteal bypass grafts were performed as follows: 6 monolateral and 2 bilateral above the knee, and 2 monolateral and 2 bilateral below the knee. Patients received ticlopidine (250 mg/day) after surgery. Duplex ultrasound graft surveillance was routinely performed.

There were no early or late deaths. At the follow-up, ranging from one to eighteen months, all the grafts were patent. Although some authors do not recommend the use of cryopreserved saphenous vein allografts, particularly for complex limb-salvage procedures, the present authors believe that these conduits can be used with good graft patency rates in the absence of a suitable alternative.

The authors expect that long-term results will supply further information on the graft patency rates and on possibly greater use of venous allografts in arterial surgery of the lower extremities.